Intraoperative Strahlentherapie für Brustkrebs - Medizintechnik

Behandlung

Intraoperative Strahlentherapie (IORT) für Brustkrebs

Bei der intraoperativen Strahlentherapie für Brustkrebs wurde in den letzten Jahren ein Weg beschritten, der weg von radikalen Operationsmethoden hin zu einer weniger invasiven, brusterhaltenden Therapie (BET) führte. Ein solcher Wandel zeigt sich nun auch in der Strahlentherapie. Anstelle eines standardisierten Behandlungsplanes wird bei der IORT eine risikoadaptierte Therapie vorgenommen, die den individuellen Risikofaktoren der Patientinnen besser Rechnung trägt und deutlich mehr Behandlungskomfort bietet.

Anders als bei der externen Bestrahlung wird mit dem INTRABEAM^®von ZEISS das Tumorbett gezielt bestrahlt und umliegendes gesundes Gewebe geschont. Bei der IORT für Brustkrebs erfolgt sofort nach der Tumorresektion noch während der Operation eine zirka 30 minütige Bestrahlung. Dadurch wird die herkömmliche, circa sechs Wochen dauernde Nachbestrahlung verkürzt oder kann bei ausgewählten Patientinnen mit niedrigem Risikoprofil sogar ganz entfallen.^1,2

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Intraoperative Strahlentherapie für Brustkrebs TARGIT vs EBRT

Strahlentherapien – risikoadaptierte Alternativen nach brusterhaltender Behandlung

TARGIT Boost Bestrahlung

TARGIT Einmalbestrahlung

Behandlungsschritte

Intraoperative Strahlentherapie für Brustkrebs 1

Schritt 1 Die Position des Tumors wird ermittelt.

Intraoperative Strahlentherapie für Brustkrebs 2

Schritt 2 Während der Operation wird ein minimal invasiver Zugangspunkt geschaffen.

Intraoperative Strahlentherapie für Brustkrebs 3

Schritt 3 Der Tumor wird operativ entfernt.

Intraoperative Strahlentherapie für Brustkrebs 4

Schritt 4 Der passende Applikator (Ø) wird bestimmt und in der Tumorhöhle platziert.

Intraoperative Strahlentherapie für Brustkrebs 5

Schritt 5 Das Tumorbett wird für ca. 30 Minuten lokal bestrahlt.

Intraoperative Strahlentherapie für Brustkrebs 6

Schritt 6 Der Applikator wird entfernt und die Wunde wird geschlossen.

TARGIT-A

The TARGIT-A Trial: „Risk-adapted targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial.“ ¹

_{Jayant S Vaidya, Frederik Wenz, Max Bulsara, Jeffrey S Tobias, David J Joseph, Mohammed Keshtgar, Henrik L Flyger, Samuele Massarut, Michael Alvarado, Christobel Saunders, Wolfgang Eiermann, Marinos Metaxas, Elena Sperk, Marc Sütterlin, Douglas Brown, Laura Esserman, Mario Roncadin, Alastair Thompson, John A Dewar, Helle M R Holtveg, Steffi Pigorsch, Mary Falzon, Eleanor Harris, April Matthews, Chris Brew-Graves, Ingrid Potyka, Tammy Corica, Norman R Williams, Michael Baum, on behalf of the TARGIT trialists’ group.}

Die TARGIT-A Studienergebnisse zeigen, dass diese Methode der konventionellen externen Bestrahlung (EBRT) beim invasiv-duktalen Mammakarzinom nicht unterlegen ist. Nach einem Follow-up von 5 Jahren konnte kein statistisch
signifikanter Unterschied zwischen der Lokalrezidivrate (primärer Endpunkt) bei der EBRT und TARGIT festgestellt werden. Für die Patientinnen bietet die TARGIT Einmalbestrahlung entscheidende Vorteile: durch die einmalige, zielgerichtete
Bestrahlung direkt im Tumorbett kann die Behandlungsdauer auf ca. 30 Minuten verkürzt werden.

Podcast von „The Lancet“ über die 5-Jahresergebnisse der Targit-A Studie

Studiendesign

Intraoperative Strahlentherapie für Brustkrebs Weltkarte Thumbnail

Studien Design

Die TARGIT-A Studie ist momentan die größte multizentrische, randomisierte klinische Studie im Bereich der verkürzten Teilbrustbestrahlung (APBI). In 33 Zentren aus 11 Ländern wurde bei 3451 Patientinnen mit günstiger Prognose die gezielte intraoperative Strahlentherapie (TARGIT) durchgeführt.

Intraoperative Strahlentherapie für Brustkrebs Patienten Thumbnail

Patienten Charakteristika

Für die TARGIT-A Studie wurden Patientinnen mit günstigem Risikoprofil ausgewählt, jedoch nicht ausschließlich ältere. Außerdem gab es auch eine erhebliche Anzahl von Patientinnen mit negativer Prognose.

Zusammenfassung der Ergebnisse

Intraoperative Strahlentherapie für Brustkrebs TARGIT EBRT Thumbnail

Effektivität von TARGIT im Vergleich zu EBRT

Die Ergebnisse zum ipsilateralen Rezidiv zeigen, dass es bei Patientinnen nach 5 Jahren keinen signifikanten Unterschied zwischen der TARGIT Behandlung während der Lumpektomie-OP und der EBRT Behandlung gibt.

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Intraoperative Strahlentherapie für Brustkrebs TAGRIT EBRT Mortalität Thumbnail

Nicht-Brustkrebs Todesfälle

Im Studienarm, bei dem die TARGIT Behandlung während der Lumpektomie-OP durchgeführt wurde, gab es im Vergleich zu EBRT signifikant weniger Todesfälle, welche nicht durch Brustkrebs verursacht wurden, sondern kardiovaskulär oder durch andere Krebsarten bedingt waren.

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Intraoperative Strahlentherapie für Brustkrebs TARGIT EBRT Haut Thumbnail

Grad 3 oder 4 Hautkomplikationen

Wundkomplikationen waren in beiden Gruppen ähnlich. Im Vergleich zur EBRT konnten jedoch Grad 3 oder 4 Hautkomplikationen durch TARGIT signifikant reduziert werden.

6 Monate nach der Randomisierung konnten keine signifikanten Unterschiede zwischen den Wundkomplikationen (sekundärer Endpunkt) bei EBRT und TARGIT festgestellt werden.

n = 3451	TARGIT	EBRT
Wundkomplikationen
Hämatom / Serom, welches mehr als 3 Aspirationen oder operativen Eingriff erfordert	4	2
Wundinfektion, welche intravenöse Antibiose oder operative Intervention erfordert	12	9
Hautschäden / verzögerte Wundheilung	3	5
Total	19 (1.1%)	16 (0.9%)
	p = 0.599
Strahleninduzierte Komplikationen
Strahleninduzierte Grad 3 oder 4 Hautkomplikation gemäß der Radiaton Therapy Oncology Group (RTOG)	4 (0.2%)	13 (0.8%)
	p = 0.029

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Studienfazit

Die randomisierte, multizentrische klinische Studie belegt, dass die gezielte intraoperative Radiotherapie (TARGIT) mit dem INTRABEAM^® von ZEISS der externen Bestrahlung (EBRT) nicht unterlegen ist.

“The most important benefit of TARGIT for a woman with breast cancer is that it allows her to complete her entire local treatment at the time of her operation, with lower toxicity to the breast, the heart and other organs. Our research supports the use of TARGIT concurrent with lumpectomy, provided patients are selected carefully, and should allow patients and their clinicians to make a more informed choice about individualizing their treatment, saving time, money, breasts, and lives.”

_{Professor Jayant Vaidya (FRCS MD, PhD)³

Clinical Trials Group, Division of

Surgery and Interventional

Science, University College

London, London, UK}

Intraoperative Strahlentherapie für Brustkrebs 5-Jahres Resultate Thumbnail

Literatur

Literaturübersicht

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2. Brustkrebs

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Vaidya, J. S., Baum, M., Tobias, J. S., Massarut, S., Wenz, F., Murphy, O., … Joseph, D. (2006). Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. International Journal of Radiation Oncology*Biology*Physics, 66(5), 1335–1338.

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Vaidya, J. (2013). “1-stop” radiotherapy could offer an alternative to lengthy and inconvenient post-surgery procedures for breast cancer

Vaidya, J. S., Wenz, F., Bulsara, M., Tobias, J. S., Joseph, D. J., Keshtgar, M., … Baum, M. (2014). Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet, 383(9917), 603–613.

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Wasser, K., Schoeber, C., Kraus-Tiefenbacher, U., Bauer, L., Brade, J., Teubner, J., … Neff, W. (2007). Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer. European Radiology, 17(7), 1865–74.

Welzel, G., Blank, E., Kraus-Tiefenbacher, U., Keller, A., Vorodi, F., Herskind, C., … Wenz, F. K. (2008). The influence of the interval between IORT during breast-conserving surgery and external beam radiotherapy (EBRT) on late toxicity. Journal of Clinical Oncology, 26, 630.

Welzel, G., Boch, A., Sperk, E., Hofmann, F., Kraus-Tiefenbacher, U., Gerhardt, A., … Wenz, F. (2013). Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiation Oncology, 8(1), 9.

Wenz, F., Welzel, G., Keller, A., Blank, E., Vorodi, F., Herskind, C., … Kraus-Tiefenbacher, U. (2008). Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast, 17(6), 617–622.

Wenz, F., Welzel, G., Blank, E., Hermann, B., Steil, V., Sütterlin, M., Kraus-Tiefenbacher, U. (2010). Intraoperative Radiotherapy as a Boost During Breast-Conserving Surgery Using Low-Kilovoltage X-Rays: The First 5 Years of Experience With a Novel Approach. International Journal of Radiation Oncology*Biology*Physics, 77(5), 1309–1314.

Wenz, F., Blank, E., Welzel, G., Hofmann, F., Astor, D., Neumaier, C., … Kraus-Tiefenbacher, U. (2012). Intraoperative radiotherapy during breast-conserving surgery using a miniature x-ray generator (Intrabeam ® ): theoretical and experimental background and clinical experience. Women’s Health, 8(1), 39–47.

Wenz, F., Sedlmayer, F., Herskind, C., Welzel, G., Sperk, E., Neumaier, C., … Sütterlin, M. (2015). Accelerated Partial Breast Irradiation in Clinical Practice. Breast Care, 10(4), 247–252.

Williams, N. R., Pigott, K. H., Brew-Graves, C., Keshtgar, M. R. S. (2014). Intraoperative radiotherapy for breast cancer. Gland Surgery, 3(2), 109–119.

3. Gastrointestinale Tumoren

Algur, E., Mahadevan, A., Deibel, C. (2005). Interstitial photon radiosurgery system for re-current and locally advanced rectal cancer: a retrospective review of 24 patients. ASCO Gastrointestinal Cancers Symposium, Jan 27–29, Hollywood, Florida, USA, Abstract No 208.

Brady, J. T., Crawshaw, B. P., Murrell, B., Dosokey, E. M. G., Jabir, M. A., Steele, S. R., … Reynolds, H. L. (2017). Influence of intraoperative radiation therapy on locally advanced and recurrent colorectal tumors: A 16-year experience. The American Journal of Surgery.

Guo, S., Reddy, C. A., Kolar, M., Woody, N., Mahadevan, A., Deibel, F., … Suh, J. H. (2012). Intraoperative radiation therapy with the photon radiosurgery system in locally advanced and recurrent rectal cancer: retrospective review of the Cleveland clinic experience. Radiation Oncology, 7(1), 110.

Haddock, M. G. (2016). Irradiation of Very Locally Advanced and Recurrent Rectal Cancer. Seminars in Radiation Oncology, 26(3), 226–235.

Haddock, M. G. (2017). Intraoperative radiation therapy for colon and rectal cancers: a clinical review. Radiation Oncology, 12(1), 11.

Lyadov, K., Krymskiy, V., Markin, A., Krymskiy, A. (2008). Evaluation of safety of intraoperative radiotherapy using the intra beam system in combined treatment of gastric cancer. Poster Abstract Presented at the ISIORT Meeting.

Lyadov, K., Yu, S., Krymskiy, V., Krymskiy, A. (2008). Improvement of Curativity of Video-Assisted Surgery for Colorectal Cancer Due to Intra-Operative Contact Radiotherapy Using the INTRA BEAM System. ISIORT.

National Comprehensive Cancer Network® - Guidelines for Colon & Rectal Cancer, 2016

Polkowski, W. P., Skórzewska, M. (2014). Intraoperative Radiotherapy with Low-Energy Photons in Rectal Cancer Recurrence. (M. Keshtgar, K. Pigott, & F. Wenz, Eds.), Targeted Intraoperative Radiotherapy in Oncology. Berlin, Heidelberg: Springer Berlin Heidelberg.

Potemin, S., Uvarov, I., Vasilenko, I. (2015). Intraoperative radiotherapy in locally-advanced and recurrent rectal cancer: retrospective review of 68 cases. Transl Cancer Res, 4(2), 189–195.

Skórzewska, M., Mielko, J., Kurylcio, A., Romanek, J., Polkowski, W. P. (2016). Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: a single centre retrospective study. Współczesna Onkologia, 20(1), 52–57.

Susko, M., Lee, J., Salama, J., Thomas, S., Uronis, H., Hsu, D., … Palta, M. (2016). The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer. Annals of Surgical Oncology.

4. Kopf & Hals Tumoren

Abo-Madyan, Y., Gößler, U., Vent, J., Nwankwo, C., Schneider, F., Hörmann, K., Wenz, F. (2013). Intraoperative Radiotherapie for recurrent Head & Neck Squamous Cell Carcinoma using a mobile 50kV mini accelerator. DEGRO 2013, Poster.

Chen, A. M., Bucci, M. K., Singer, M. I., Garcia, J., Kaplan, M. J., Chan, A. S., Phillips, T. L. (2007). Intraoperative radiation therapy for recurrent head-and-neck cancer: The UCSF experience. International Journal of Radiation Oncology*Biology*Physics, 67(1), 122–129.

De Felice, F., Musio, D., Tombolini, V. (2016). Intraoperative radiation therapy (IORT) in recurrent head and neck cancer. Oral Oncology, 55(March), e1.

Kyrgias, G., Hajiioannou, J., Tolia, M., Kouloulias, V., Lachanas, V., Skoulakis, C., … Bizakis, I. (2016). Intraoperative radiation therapy (IORT) in head and neck cancer: A systematic review. Medicine, 95(50), e5035.

Münter, M. W., Köppen, U., Ramuscak, A., Sittel, C., Wegner, N. (2015). Intraoperative radiotherapy (IORT) in the treatment of head and neck cancer. Transl Cancer Res, 4(2), 178–181.

Roopashri, G., Baig, M. (2013). Current advances in radiotherapy of head and neck malignancies. Journal of International Oral Health, 5(6), 119–23.

Rutkowski, T., Wygoda, A., Hutnik, M., Składowski, K., Wydmański, J., Maciejewski, A., … Maciejewski, B. (2010). Intraoperative Radiotherapy (IORT) with Low-Energy Photons as a Boost in Patients with Early-Stage Oral Cancer with the Indications for Postoperative Radiotherapy. Strahlentherapie Und Onkologie, 186(9), 496–501.

5. Hautkrebs

Amini, S., Viera, M. H., Valins, W., Berman, B. (2010). Nonsurgical innovations in the treatment of nonmelanoma skin cancer. The Journal of Clinical and Aesthetic Dermatology, 3(6), 20–34.

Armoogum, K., Parry, J., Mackay, C., Thompson, A., Vaidya, J., Ackland, C., … Munro, A. (2007). Measurement of Skin Dose from Very Low Energy X-rays during Partial Breast Irradiation. Clinical Oncology, 19(3), S23.

Bhatnagar, A., Loper, A. (2010). The initial experience of electronic brachytherapy for the treatment of non-melanoma skin cancer. Radiation Oncology (London, England), 5, 87.

Chan, S., Dhadda, A.S. (2007) Swindell, R., Single fraction radiotherapy for small superficial carcinoma of the skin. Clin Oncol (R Coll Radiol), 19(4), 256-9.

Cognetta, A. B., Howard, B. M., Heaton, H. P., Stoddard, E. R., Hong, H. G., Green, W. H. (2012). Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. Journal of the American Academy of Dermatology, 67(6), 1235–41.

Bodner, W. R., Hilaris, B. S., Alagheband, M., Safai, B., Mastoras, C. A., Saraf, S. (2003). Use of low-energy X-rays in the treatment of superficial nonmelanomatous skin cancers. Cancer Investigation, 21(3), 355–362.

Ducassou, A. (2015). First experience of skin treatments with INTRABEAM at IUCT Oncopole Toulouse. In ESTRO proceeding.

Ermertcan, A. T., Hellings, P. W., Cingi, C. (2012). Nonmelanoma skin cancer of the head and neck: nonsurgical treatment. Facial Plastic Surgery Clinics of North America, 20(4), 445–54.

Goubert, M., Parent, L. (2015). Dosimetric characterization of INTRABEAM® miniature accelerator flat and surface applicators for dermatologic applications. Physica Medica, 31(3), 224–232.

Jankarashvili, N., Topeshashvili, M. (2015). Treatment of skin cancer with intrabeam. 9th ZEISS INTRABEAM User Meeting.

Levell, N. J., Igali, L., Wright, K. A., Greenberg, D. C. (2013). Basal cell carcinoma epidemiology in the UK: the elephant in the room. Clinical and Experimental Dermatology, 38(4), 367–9.

Nguyen, T. H., Ho, D. Q.-D. (2002). Nonmelanoma skin cancer. Current Treatment Options in Oncology, 3(3), 193–203.

Perkins, J. L., Liu, Y., Mitby, P. A., Neglia, J. P., Hammond, S., Stovall, M., … Mertens, A. C. (2005). Nonmelanoma skin cancer in survivors of childhood and adolescent cancer: a report from the childhood cancer survivor study. Journal of Clinical Oncology, 23(16), 3733–41.

Tward, J.D., Anker, C, J,. Gaffney, D.K., Bowen, G. . (2012). Radiation Therapy and Skin Cancer. Modern Practices in Radiation Therapy, 207–246.

6. Wirbelsäulenmetastasen

Berenson, J., Pflugmacher, R., ..., Jarzem, P. (2011) Cancer Patient Fracture Evaluation (CAFE) lnvestigators. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncology, 12(3), 225-35.

Bludau, F., Obertacke, U., Schmidt, R. (2012). First middle-term results after Kypho-IORT. European Spine Journal, 21(11), 2332.

Bludau, F. (2014). Kypho-IORT: Intraoperative Radiotherapy in Spinal Metastases: Nine-Month Clinical Results. The Spine Journal, 14(11), S163

Bludau, F., Reis, T., Schneider, F., Clausen, S., Wenz, F., Obertacke, U. (2015). Kyphoplastie kombiniert mit intraoperativer Radiotherapie (Kypho-IORT). Der Radiologe, 55(10), 859–867.

Kayser, R., Ender, S. A., Asse, E., Wilhelm, E., Adler, F., Schmidt, R., … Bludau, F. (2013). Kyphoplastie in Kombination mit intraoperativer Radiotherapie. Der Orthopäde, 42(9), 765–771.

Miglierini, P., Dam-Hieu, P., Key, S. (2014). Kypho-IORT: the first French treatment. Translational Cancer Research, 3(1).

Reis, T., Schneider, F., Hermann, B., Bohrer, M., Schmitt, R., Obertacke, U., Wenz, F. (2010). Kypho-IORT: A novel treatment of spinal metastases with intraoperative radiotherapy during kyphoplasty. International Journal of Radiation Oncology Biology Physics, 78(3), S581–S582.

Reis, T., Schneider, F., Welzel, G., Schmidt, R., Bludau, F., Obertacke, U., Wenz, F. (2012). Intraoperative radiotherapy during kyphoplasty for vertebral metastases (Kypho-IORT): first clinical results. Tumori, 98(4), 434–40.

Reis, T., Sperk, E., Schneider, F., Schmidt, R., Obertacke, U., Wenz, F. (2012). Kypho-IORT for spinal metastasis: a case study. Hospital Oncology & Haematology Europe, Campden Publishing Ltd, Apr, 21-24.

Schmidt, R., Obertacke, U., Wenz, F., Reis, T., Schneider, F. (2010). Clinical feasibility of a new minimal invasive intraoperative radiation in combination with balloon kyphoplasty (Kypho-IORT) for spinal metastases. European Spine Journal, 19(11), 2049.

Schmidt, R., Wenz, F., Reis, T., Janik, K., Bludau, F., Obertacke, U. (2012). Kyphoplasty and intra-operative radiotheray, combination of kyphoplasty and intra-operative radiation for spinal metastases: technical feasibility of a novel approach. International Orthopaedics, 36(6), 1255–1260.

Schneider, F., Greineck, F., Clausen, S., Mai, S., Obertacke, U., Reis, T., Wenz, F. (2011). Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT). International Journal of Radiation Oncology*Biology*Physics, 81(4), 1114–1119.

Wenz, F., Schneider, F., Neumaier, C., Kraus-Tiefenbacher, U., Reis, T., Schmidt, R., Obertacke, U. (2010). Kypho-IORT - a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiation Oncology, 5(1), 11.

7. Medizinphysik

Armoogum, K. S., Parry, J. M., Souliman, S. K., Sutton, D. G., Mackay, C. D. (2007). Functional intercomparison of intraoperative radiotherapy equipment - Photon Radiosurgery System. Radiation Oncology, 2(1), 11.

Eaton, D. J., Duck, S. (2010). Dosimetry measurements with an intra-operative x-ray device. Physics in Medicine and Biology, 55(12), N359–N369.

Eaton, D. J., Gonzalez, R., Duck, S., Keshtgar, M. (2011). Radiation protection for an intra-operative X-ray device. The British Journal of Radiology, 84(1007), 1034–1039.

Eaton, D. J., Best, B., Brew-Graves, C., Duck, S., Ghaus, T., Gonzalez, R., … Keshtgar, M. R. S. (2012). In Vivo Dosimetry for Single-Fraction Targeted Intraoperative Radiotherapy (TARGIT) for Breast Cancer. International Journal of Radiation Oncology*Biology*Physics, 82(5), e819–e824.

Eaton, D. J. (2012). Quality assurance and independent dosimetry for an intraoperative x-ray device. Medical Physics, 39(11), 6908.

Ebert, M. A., Asad, A. H., Siddiqui, S. A. (2009). Suitability of radiochromic films for dosimetry of very-low energy X-rays. Journal of Applied Clinical Medical Physics / American College of Medical Physics, 10(4), 2957.

Cardoso, M. J., Cardoso, J. S., Oliveira, H. P., Gouveia, P. (2016). The breast cancer conservative treatment. Cosmetic results – BCCT.core – Software for objective assessment of esthetic outcome in breast cancer conservative treatment: A narrative review. Computer Methods and Programs in Biomedicine, 126, 154–159.

Chiavassa, S., Buge, F., Hervé, C., Delpon, G., Rigaud, J., Lisbona, A., Supiot, S. (2015). Monte Carlo evaluation of the effect of inhomogeneities on dose calculation for low energy photons intra-operative radiation therapy in pelvic area. Physica Medica, 31(8), 956–962.

Darby, S. C., Ewertz, M., McGale, P., Bennet, A. M., Blom-Goldman, U., Brønnum, D., … Hall, P. (2013). Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. New England Journal of Medicine, 368(11), 987–998.

Eaton, D. J., Earner, B., Faulkner, P., Dancer, N. (2013). A national dosimetry audit of intraoperative radiotherapy. The British Journal of Radiology, 86(1032), 20130447.

Emami, B., Woloschak, G., Small Jr, W. (2015). Beyond the linear quadratic model : intraoperative radiotherapy and normal tissue tolerance. Transl Cancer Res, 4(2), 140–147.

Goubert, M., Parent, L. (2015). Dosimetric characterization of INTRABEAM^® miniature accelerator flat and surface applicators for dermatologic applications. Physica Medica, 31(3), 224–232.

Härtl, P. M., Dobler, B., Kölbl, O., Treutwein, M. (2009). Praktische Dosimetrie und Konstanzprüfung zur Einführung der intraoperativen Bestrahlung mit Intrabeam^®(Zeiss). Zeitschrift Für Medizinische Physik, 19(4), 288–293.

Hill, R., Healy, B., Holloway, L., Kuncic, Z., Thwaites, D., Baldock, C. (2014). Advances in kilovoltage x-ray beam dosimetry. Physics in Medicine and Biology, 59(6), R183–R231.

Keshtgar, M. R. S., Williams, N. R., Bulsara, M., Saunders, C., Flyger, H., Cardoso, J. S., … Joseph, D. J. (2013). Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Research and Treatment, 140(3), 519–525.

Xu, Y., & Lam, S. (2013). Dosimetric Characteristic of Zeiss IntraBeam Flat and Surface Applicators. Medical Physics, 40(6), 284–284.

Lam, S. C. P., Xu, Y., West, M. (2016). Shielding Effects on Low-KVIORT Forward Projecting Applicators. EC Cancer, 2(1), 64–75.

Muralidhar, K. R., Rout, B., Mallikarjuna, A., Poornima, A., Murthy, P. N. (2014). Commissioning and quality assurances of the Intrabeam Intra-Operative radiotherapy unit. International Journal of Cancer Therapy and Oncology, 2(4), 20415.

Nwankwo, O., Clausen, S., Schneider, F., Wenz, F. (2013). A virtual source model of a kilo-voltage radiotherapy device. Physics in Medicine and Biology, 58(7), 2363–2375.

Preuss, J., Lester, L., Saunders, C. (2012). BCCT.core – Can a computer program be used for the assessment of aesthetic outcome after breast reconstructive surgery? The Breast, 21(4), 597–600.

Price, C., Pederson, A., Frazier, C., Duttenhaver, J. (2013). In vivo dosimetry with optically stimulated dosimeters and RTQA2 radiochromic film for intraoperative radiotherapy of the breast. Medical Physics, 40(9), 91716.

Schneider, F., Clausen, S., Jahnke, A., Steil, V., Bludau, F., Sütterlin, M., … Wenz, F. (2014). Radiation protection for an intraoperative X-ray source compared to C-arm fluoroscopy. Zeitschrift Fur Medizinische Physik, 24(3), 243–251.

Schneider, F., Clausen, S., Thölking, J., Wenz, F., Abo-Madyan, Y. (2014). A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. Journal of Applied Clinical Medical Physics / American College of Medical Physics, 15(1), 4502.

Sethi, A., Chinsky, B., Gros, S., Diak, A. (2015). Tissue inhomogeneity corrections in low-kV intra-operative radiotherapy (IORT). Translational Cancer Research, 4(2), 182–188.

Steenbeke, F., Gevaert, T., Tournel, K., Engels, B., Verellen, D., Storme, G., Ridder, M. D. (2015). Quality Assurance of a 50-kV Radiotherapy Unit Using EBT3 GafChromic Film: A Feasibility Study. Technology in Cancer Research & Treatment, 15(1), 163–70.

Watson, P. G. F., Seuntjens, J. (2016). Technical Note: Effect of explicit M and N-shell atomic transitions on a low-energy x-ray source. Medical Physics, 43(4), 1760–1763.

Wuu, C.-S., Sheu, R.-D., Chen, J. (2015). Microdosimetric characteristics of 50 kV X rays at different depths for breast intraoperative radiotherapy. Radiation Protection Dosimetry, 166(1–4), 343–6.

8. Radiobiologie

Belletti, B., Vaidya, J. S., D’Andrea, S., Entschladen, F., Roncadin, M., Lovat, F., … Massarut, S. (2008). Targeted Intraoperative Radiotherapy Impairs the Stimulation of Breast Cancer Cell Proliferation and Invasion Caused by Surgical Wounding. Clinical Cancer Research, 14(5), 1325–1332.

Fabris, L., Berton, S., Citron, F., D’Andrea, S., Segatto, I., Nicoloso, M. S., … Belletti, B. (2016). Radiotherapy-induced miR-223 prevents relapse of breast cancer by targeting the EGF pathway. Oncogene, (February 2016), 1–13.

Herskind, C., Griebel, J., Kraus-Tiefenbacher, U., Wenz, F. (2008). Sphere of Equivalence—A Novel Target Volume Concept for Intraoperative Radiotherapy Using Low-Energy X Rays. International Journal of Radiation Oncology*Biology*Physics, 72(5), 1575–1581.

Herskind, C., Ma, L., Liu, Q., Zhang, B., Schneider, F., Veldwijk, M. R., & Wenz, F. (2017). Biology of high single doses of IORT: RBE, 5 R’s, and other biological aspects. Radiation Oncology (London, England), 12(1), 24.

Herskind, C., Schalla, S., Hahn, E. W., Höver, K.-H., ..., Wenz, F. (2006). "Influence of different dose rates on cell recovery and RBE at different spatial positions during protracted conformal radiotherapy." Radiation protection dosimetry, 122 (1-4), 498-505.

Herskind, C., Wenz, F. (2010). Radiobiological Comparison of Hypofractionated Accelerated Partial-Breast Irradiation (APBI) and Single-Dose Intraoperative Radiotherapy (IORT) with 50-kV X-Rays. Strahlentherapie Und Onkologie, 186(8), 444–451.

Herskind, C., Wenz, F. (2014). Radiobiological aspects of intraoperative tumour-bed irradiation with low-energy X-rays ( LEX-IORT ). Transl Cancer Res, 3(1), 3–17.

Liu, Q., Schneider, F., Ma, L., Wenz, F., Herskind, C. (2013). Relative Biologic Effectiveness (RBE) of 50 kV X-rays Measured in a Phantom for Intraoperative Tumor-Bed Irradiation. International Journal of Radiation Oncology*Biology*Physics, 85(4), 1127–1133.

Minafra, L., & Bravatà, V. (2014). Cell and molecular response to IORT treatment. Translational Cancer Research, 3(1), 32–47.

Sologuren, I., Rodríguez-gallego, C., & Lara, P. C. (2014). Immune effects of high dose radiation treatment: implications of ionizing radiation on the development of bystander and abscopal effects. Transl Cancer Res, 3(1), 18–31.

Woolf, D. K., Williams, N. R., Bakshi, R., Madani, S. Y., Eaton, D. J., Fawcitt, S., … Keshtgar, M. (2014). Biological dosimetry for breast cancer radiotherapy: a comparison of external beam and intraoperative radiotherapy. SpringerPlus, 3, 329.

9. Quality of Life & Cosmetic Outcome

Coombs, N. J., Coombs, J. M., Vaidya, U. J., Singer, J., Bulsara, M., Tobias, J. S., … Vaidya, J. S. (2016). Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open, 6(5).

Corica, T., Joseph, D., Saunders, C., Bulsara, M., Nowak, A. K. (2014). Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk? Radiation Oncology, 9(1), 1–9.

Corica, T., Nowak, A. K., Saunders, C. M., Bulsara, M., Taylor, M., Vaidya, J. S., … Joseph, D. J. (2016). Cosmesis and Breast-Related Quality of Life Outcomes After Intraoperative Radiation Therapy for Early Breast Cancer: A Substudy of the TARGIT-A Trial. International Journal of Radiation Oncology*Biology*Physics, 96(1), 55–64.

Cardoso, M. J., Cardoso, J. S., Oliveira, H. P., Gouveia, P. (2016). The breast cancer conservative treatment. Cosmetic results – BCCT.core – Software for objective assessment of esthetic outcome in breast cancer conservative treatment: A narrative review. Computer Methods and Programs in Biomedicine, 126, 154–159.

Cracco, S., Semprini, G., Cattin, F., Gregoraci, G., Zeppieri, M., Isola, M., … Parodi, P. C. (2015). Impact of Intraoperative Radiotherapy on Cosmetic Outcome and Complications after Oncoplastic Breast Surgery. The Breast Journal, 21(3), 285–290

Keshtgar, M. R. S., Williams, N. R., Bulsara, M., Saunders, C., Flyger, H., Cardoso, J. S., … Joseph, D. J. (2013). Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Research and Treatment, 140(3), 519–525.

Massa, M., Meszaros, P., Baldelli, I., Bisso, N., Franchelli, S. (2015). Aesthetic evaluation in oncoplastic and conservative breast surgery: a comparative analysis. Plast Reconstr Surg Glob Open, 3(3), e339.

Ng, J., Dai, T. (2016). Radiation therapy and the abscopal effect: a concept comes of age. Annals of Translational Medicine, 4(6), 118–118.

Soror, T., Kovács, G., Kovács, Á., Seibold, N., Melchert, C., Baumann, K., … Stojanovic-Rundic, S. (2016). New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale. Brachytherapy, [Epub ahead of print].

Welzel, G., Hofmann, F., Blank, E., Kraus-Tiefenbacher, U., Hermann, B., Sütterlin, M., Wenz, F. (2010). Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays. Annals of Surgical Oncology, 17(S3), 359–367.

Yu, T., Eom, K. Y., Jang, N. Y., Kim, K. S., Koo, T. R., Kwon, J., … Kim, I. A. (2016). Objective measurement of cosmetic outcomes of breast conserving therapy using BCCT.core. Cancer Research and Treatment, 48(2), 491–498.

10. Allgemeine Artikel zur IORT

Biggs, D. S., Thomson, E. S. (1996). Radiation properties of a miniature X-ray device for radiosurgery. The British Journal of Radiology, 69(822), 544–7.

Calvo, F. A. (2017). Intraoperative irradiation: precision medicine for quality cancer control promotion. Radiation Oncology, 12(1), 36.

Calvo, F. A., Sole, C. V, González, M. E., Tangco, E. D., López-Tarjuelo, J., Koubychine, I., … Ferrer, C. (2013). Research opportunities in intraoperative radiation therapy: the next decade 2013–2023. Clinical and Translational Oncology, 15(9), 683–690.

Coles, C. E., Yarnold, J. R. (2016). Accelerated partial breast irradiation: the new standard? The Lancet, 387(10015), 201–202.

Debenham, B. J., Hu, K. S., Harrison, L. B. (2013). Present status and future directions of intraoperative radiotherapy. The Lancet Oncology, 14(11), e457–e464.

Eaton, D. J. (2015). Electronic brachytherapy—current status and future directions. The British Journal of Radiology, 88(1049), 20150002.

Holmes, D. R. (2015). Intraoperative Radiotherapy of the Breast for Early-Stage Breast Cancer: Ready for Primetime. The Breast Journal, 21(2), 181–184.

Mooney, H. (2014). NICE gives go ahead to intrabeam radiotherapy for breast cancer. BMJ, 349(jul28 6), g4863–g4863.

Kalakota, K., Small, W. (2014). Intraoperative radiation therapy techniques and options for breast cancer. Expert Review of Medical Devices, 11(3), 265–73.

Paolo, V., De Lorenzi Francesca, Pietro, L., Mario, R., Umberto, V. (2016). Current Trends in the Oncologic and Surgical Managements of Breast Cancer in Women with Implants: Incidence, Diagnosis, and Treatment. Aesthetic Plastic Surgery, 40(2), 256–265.

Thariat, J., Hannoun-Levi, J.-M., Sun Myint, A., Vuong, T., Gérard, J.-P. (2012). Past, present, and future of radiotherapy for the benefit of patients. Nature Reviews Clinical Oncology, 10(1), 52–60.

Tobias, J. S., Vaidya, J. S., Keshtgar, M., D’Souza, D. P., Baum, M. (2004). Reducing radiotherapy dose in early breast cancer: the concept of conformal intraoperative brachytherapy. The British Journal of Radiology, 77(916), 279–84.

11. Leitlinien

AGO. (2014). Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer, Guidelines(Ver. 1).

Aetna. (2015). Intraoperative Radiation Therapy (IORT).

DEGRO. (n.d.). Leitlinie zur Weiterbildung zum Facharzt für Strahlentherapie.

Gnant, M., Harbeck, N., Thomssen, C. (2011). St. Gallen 2011: Summary of the consensus discussion. Breast Care, 6(2), 136–141.

Goldhirsch, A., Wood, W. C., Coates, A. S., Gelber, R. D., Thürlimann, B., Senn, H. J. (2011). Strategies for subtypes-dealing with the diversity of breast cancer: Highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2011. Annals of Oncology, 22(8), 1736–1747.

NCCN. (2015). NCCN Clinical Practice Guidelines in Oncology - Breast Cancer.

NCCN. (2016). NCCN Clinical Practice Guidelines in Oncology - Colon Cancer.

NCCN. (2016). NCCN Clinical Practice Guidelines in Oncology - Rectal Cancer.

Polgár, C., Limbergen, E. Van, Pötter, R., Kovács, G., Polo, A., Lyczek, J., … Strnad, V. (2010). Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group. Radiotherapy and Oncology, 94(3), 264–273.

Sedlmayer, F., Sautter-Bihl, M. L., Budach, W., Dunst, J., Fastner, G., Feyer, P., … Sauer, R. (2013). DEGRO practical guidelines: Radiotherapy of breast cancer I: Radiotherapy following breast conserving therapy for invasive breast cancer. Strahlentherapie Und Onkologie, 189(10), 825–833.

Smith, B. D., Arthur, D. W., Buchholz, T. A., Haffty, B. G., Hahn, C. A., Hardenbergh, P. H., … Harris, J. R. (2009). Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO). International Journal of Radiation Oncology*Biology*Physics, 74(4), 987–1001.

12. Klinische Studien

Institut du Cancer de Montpellier - Val d'Aurelle. Feasibility Clinical Trial of Intraoperative Radiotherapy (IORT) and Second Breast-conserving-surgery After Local Recurrence of Breast Carcinoma. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02386371.

Liao Ning. Intra-operative Radiotherapy For Women With Ductal Carcinoma in Situ Breast Cancer After Nipple-sparing Mastectomy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02389686.

Liao Ning. Intra-operative Radiotherapy After Breast-conversing Surgery in Treating Women With Ductal Carcinoma in Situ Breast Cancer. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02389673.

Loyola University. Combining Intraoperative Radiotherapy With Kyphoplasty for Treatment of Spinal Metastases. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02480036.

Loyola University. Phase I Study of Low Kilovoltage Intraoperative Radiation for Patients With Resectable Pancreatic Adenocarcinoma. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Jul 14]. NLM Identifier: NCT02599662

Universitätsmedizin Mannheim. A Multicenter Randomized Phase III Trial on INTraoperative RAdiotherapy in Newly Diagnosed GliOblastoma Multiforme (INTRAGO II). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02685605.

Universitätsmedizin Mannheim. INTRAGO-Intraoperative Radiotherapy for Glioblastoma - a Phase I/II Study. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02104882.

Universitätsmedizin Mannheim. Intraoperative Radiotherapy During Kyphoplasty/Vertebroplasty (Kypho-IORT) Versus EBRT in the Treatment of Painful Vertebral Metastases - a Randomized Prospective Phase III Study -. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Jul 14]. NLM Identifier: NCT02773966.

Universitätsmedizin Mannheim. TARGIT-C(Consolidation) Prospective Phase IV Study of Intraoperative Radiotherapy (IORT) in Patients With Small Breast Cancer. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT02290782.

Universitätsmedizin Mannheim. TARGeted Intraoperative radioTherapy With the INTRABEAM-System as an Advanced Boost in Patients With Breast Cancer - A Quality Control Registry in Germany (TARGIT BQR). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01440010.

University College, London. An International Randomised Controlled Trial to Compare Targeted Intra-operative Radiotherapy Boost With Conventional External Beam Radiotherapy Boost After Lumpectomy for Breast Cancer in Women With a High Risk of Local Recurrence. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01792726.

University of California, San Francisco. Targeted Intraoperative Radiotherapy United States (TARGIT-US) Phase IV Registry Trial: A Registry Trial of Targeted Intraoperative Radiation Therapy Following Breast-conserving Surgery. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT01570998.

University of Dundee. Intraoperative Radiotherapy (IORT) for Rectal Cancer Using the Photon Radiosurgery System (PRS): A Phase I Clinical Trial. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Sep 06]. NLM Identifier: NCT00910494.

Mediathek

Produkte

IORT von ZEISS

Erfahren Sie neue Fakten über Krebs und die Vorteile der intraoperativen Strahlentherapie (IORT) zur Behandlung dieser Erkrankung. Lernen Sie die verschiedenen onkologischen Indikationen kennen, welche ZEISS bereits unterstützt und wie IORT von ZEISS Ihrem Strahlentherapie Umfeld helfen kann.

INTRABEAM 600 von ZEISS - Die dritte Generation

Die erste voll integrierte Behandlungsplattform mit DICOM-Konnektivität für die intraoperative Strahlentherapie mit dem INTRABEAM 600 von ZEISS vereint unterschiedlichste klinische Anforderungen in einer Lösung.

Wie die Röntgenstrahlenquelle (XRS) des INTRABEAM^® von ZEISS funktioniert

In diesem Video werden die Komponenten und die Funktionsweise der XRS beschrieben. Erfahren Sie was während einer IORT Behandlung im Inneren der XRS passiert.

Indikationen

Wie IORT für Brustkrebs funktioniert

Dieses Video zeigt eine brusterhaltende Operation (BET) mittels IORT und beschreibt die verschiedenen Behandlungsschritte während des Eingriffs.

Wie Kypho-IORT für Wirbelsäulenmetastasen funktioniert

Dieses Video zeigt die verschiedenen Workflow-Schritte der Kypho-IORT Technik, die während der Behandlung eines Patienten mit Wirbelsäulenmetastasen durchgeführt werden.

Wie IORT mit Vertebroplastie für Wirbelsäulenmetastasen funktioniert

Dieses Video zeigt die verschiedenen Workflow-Schritte bei einer Vertebroplastie mit kombinierter IORT, die während der Behandlung eines Patienten mit Wirbelsäulenmetastasen durchgeführt werden.

Brustkrebs